This invention relates to pharmaceutical compositions comprising an equilibrium mixture of isomers of an azalide antibiotic compound and to methods for preparing them. This invention further relates to stabilized forms of the aforementioned compositions and to methods of stabilizing them. This invention further relates to methods for treating a mammal comprising administering to a mammal in need of such treatment a pharmaceutical composition of the invention.
Macrolide antibiotic agents active against a wide variety of bacterial and protozoa infections in mammals, fish and birds have been previously reported (see, e.g., International Patent Publications WO 98/56802 and WO 99/12552). These compounds generally have a macrocyclic lactone ring of 12 to 22 carbon atoms to which one or more sugar moieties are attached. Macrolide antibiotics act on the 50S ribosomal subunit to inhibit protein synthesis in microorganisms. Examples of macrolide antibiotics include lincomycin, azithromycin, which is a derivative of erythromycin A, and other azalide compounds.
Development of pharmaceutical compositions containing azalide compounds as the active ingredient has presented significant challenges. Some azalides are capable of isomerizing in solution. Consequently, the production of a reproducible antibiotic composition comprising a single isomer or a fixed ratio of isomers has been difficult. Second, a composition containing a fixed amount of a particular azalide isomer may change over time. Third, the lactone ring and sugars of azalides are easily hydrolyzed in even mildly acidic or basic pH environments, decreasing the potency and shelf-life of an antibiotic composition.
Accordingly, it is an object of the present invention to provide antibiotic compositions, and methods for preparing them, that overcome the above-mentioned disadvantages.
Citation of any reference herein shall not be construed as indicating that such reference is prior art to the present invention.
In a first embodiment, the present invention relates to a composition comprising: (a) the compound of formula I 
and the compound of formula II: 
in a ratio of about 90%xc2x14% to about 10%xc2x14%, respectively; (b) water; and (c) one or more acids present at a total concentration of from about 0.2 mmol to about 1.0 mmol per mL of the composition.
The present invention relates to a method for obtaining a composition comprising: (a) the compound of formula I and the compound of formula II in a ratio of about 90%xc2x14% to about 10%xc2x14%, respectively; (b) water; and (c) one or more acids present at a total concentration of from about 0.2 mmol to about 1.0 mmol per mL of the composition, comprising the step of heating to a temperature of about 50xc2x0 C. to about 90xc2x0 C. a mixture comprising: (i) the compound of formula (I), (ii) water, and (iii) one or more acids in a total amount ranging from about 0.2 mmol to about 1.0 mmol per mL of the mixture.
The present invention relates to a composition comprising: (a) a mixture comprising: (i) the compound of formula (I) and the compound of formula (II) in a ratio of about 90%xc2x14% to about 10%xc2x14%, respectively; (ii) water; and (iii) one or more acids present at a total concentration of from about 0.2 mmol to about 1.0 mmol per mL of the mixture; and (b) one or more water-miscible co-solvents present in a total amount of from about 250 to about 750 mg per mL of the composition.
The present invention relates to a method for obtaining a composition comprising: (a) a mixture comprising: (i) the compound of formula (I) and the compound of formula (II) in a ratio of about 90%xc2x14% to about 10%xc2x14%, respectively; (ii) water; and (iii) one or more acids present at a total concentration of from about 0.2 mmol to about 1.0 mmol per mL of the mixture; and (b) one or more water-miscible co-solvents present in a total amount of from about 250 to about 750 mg per mL of the composition, comprising heating to a temperature of about 50xc2x0 C. to 90xc2x0 C. a mixture comprising the compound of formula (I), water and one or more acids in an amount ranging from about 0.2 mmol to about 1.0 mmol per mL of the mixture, wherein one or more water-miscible co-solvents is added before, during or after the heating step, in an amount of from about 250 to about 750 mg per mL of the composition. In a preferred embodiment, the water-miscible co-solvent is added after the heating step.
The present invention relates to a method for preserving the structural integrity of the compound of formula I or the compound of formula II comprising the step of forming a composition by adding one or more water-miscible co-solvents to a mixture comprising: (a) the compound of formula (I) and the compound of formula (II); (b) water; and (c) one or more acids present in a total amount of from about 0.2 mmol to about 1.0 mmol per mL of the mixture, the amount of added water-miscible co-solvent being about 250 to about 750 mg per mL of the composition.
In an embodiment of any of the above methods, the pH of the mixture ranges from about 5.0 to about 8.0, and more preferably, from about 5.0 to about 6.0.
In an embodiment of any of the above methods, the heating takes place for about 0.5 to about 24 hours, and more preferably, from about 1 to about 8 hours.
In an embodiment of any of the compositions or methods of the invention, the concentration of the compound of formula (I) in the mixture, i.e., before the heating step, ranges from about 50 mg to about 500 mg per mL of the mixture. In a preferred embodiment thereof, the concentration ranges from about 50 mg/mL to about 200 mg/mL.
In an embodiment of any of the compositions or methods of the invention the concentration of the first mixture (of compound I and compound II) in the composition ranges from about 50 mg/mL to about 200 mg/mL of the composition. In a preferred embodiment thereof, the concentration of the first mixture in the composition ranges from about 75 to about 150 mg/mL, and more preferably from about 90 mg/mL to about 110 mg/mL of the composition.
In an embodiment of any of the compositions or methods of the invention, the one or more acids are selected from the group consisting of acetic acid, benzenesulfonic acid, citric acid, hydrobromic acid, hydrochloric acid, D- and L-lactic acid, methanesulfonic acid, phosphoric acid, succinic acid, sulfuric acid, D- and L-tartaric acid, p-toluenesulfonic acid, adipic acid, aspartic acid, camphorsulfonic acid, 1,2-ethanedisulfonic acid, laurylsulfuric acid, glucoheptonic acid, gluconic acid, 3-hydroxy-2-naphthoic acid, 1-hydroxy-2-naphthoic acid, 2-hydroxyethanesulfonic acid, malic acid, mucic acid, nitric acid, naphthalenesulfonic acid, palmitic acid, D-glucaric acid, stearic acid, maleic acid, malonic acid, fumaric acid, benzoic acid, cholic acid, ethanesulfonic acid, glucuronic acid, glutamic acid, hippuric acid, lactobionic acid, lysinic acid, mandelic acid, napadisylic acid, nicotinic acid, polygalacturonic acid, salicylic acid, sulfosalicylic acid, tryptophanic acid, and mixtures thereof. In a preferred embodiment thereof, the one or more acids is citric acid. In a more preferred embodiment thereof, the citric acid is present in an amount of from about 0.02 mmol to about 0.3 mmol per mL of composition. In another preferred embodiment thereof, the one or more acids are citric acid and hydrochloric acid. In a more preferred embodiment thereof, citric acid is present in an amount of from about 0.02 mmol to about 0.3 mmol per mL of composition and the hydrochloric acid is present in an amount sufficient to achieve a composition pH of about 5 to about 6.
In an embodiment of any of the compositions or methods of the invention, the one or more water-miscible co-solvents are selected from the group consisting of ethanol, isopropanol, diethylene glycol monomethyl ether, diethylene glycol butyl ether, diethylene glycol monoethyl ether, diethylene glycol dibutyl ether, polyethylene glycol-300, polyethylene glycol-400, propylene glycol, glycerine, 2-pyrrolidone, N-methyl 2-pyrrolidone, glycerol formal, dimethyl sulfoxide, dibutyl sebecate, polysorbate 80, and mixtures thereof. In a preferred embodiment thereof, the one or more water-miscible co-solvents is propylene glycol. In a more preferred embodiment thereof, the propylene glycol is present in an amount of from about 450 to about 550 mg per mL of the composition.
In an embodiment of any of the compositions or methods of the invention, the composition further comprises one or more antioxidants present in an amount of from about 0.01 mg to about 10 mg per mL of the composition. In a preferred embodiment thereof, the one or more antioxidants is selected from the group consisting of sodium bisulfite, sodium sulfite, sodium metabisulfite, sodium thiosulfate, sodium formaldehyde sulfoxylate, L-ascorbic acid, erythorbic acid, acetylcysteine, cysteine, monothioglycerol, thioglycollic acid, thiolactic acid, thiourea, dithiothreitol, dithioerythreitol, glutathione, ascorbyl palmitate, butylated hydroxyanisole, butylated hydroxytoluene, nordihydroguaiaretic acid, propyl gallate, xcex1-tocopherol, and mixtures thereof. In a more preferred embodiment thereof, the one or more antioxidants is monothioglycerol. In an especially preferred embodiment thereof, monothioglycerol is present in an amount of from about 4 mg/mL to about 6 mg/mL of the composition.
In an embodiment of any of the compositions or methods of the invention, the composition further comprises one or more preservatives. In a preferred embodiment thereof, the one or more preservatives are present in an amount of from about 0.01 to about 10 mg per mL of the pharmaceutical compositions. Preferably, the one or more preservatives is phenol and present in an amount of from about 2.0 to about 5.0 mg per mL, more preferably, from about 2.0 to about 3.0 mg per mL, of the pharmaceutical compositions. In another preferred embodiment thereof, the one or more preservatives are selected from benzalkonium chloride, benzethonium chloride, benzoic acid, benzyl alcohol, methylparaben, ethylparaben, propylparaben, butylparaben, sodium benzoate, phenol, and mixtures thereof. In a more preferred embodiment thereof, the one or more preservatives are selected from the group consisting of benzyl alcohol, methylparaben, propylparaben, a methylparaben/propylparaben combination, and phenol. In a particularly preferred embodiment thereof, the preservative is phenol. In a still further embodiment thereof, the preservative is phenol present in an amount of from about 2.0 to about 3.0 mg per mL of the pharmaceutical composition.
In an especially preferred embodiment of the composition of this invention, the one or more acids are citric acid present in an amount of from about 0.02 mmol to about 0.3 mmol per mL of composition and hydrochloric acid is present in an amount sufficient to achieve a composition pH of about 5 to about 6; the one or more water-miscible co-solvents is propylene glycol present in an amount of from about 450 to about 550 mg per mL of the composition; and the composition further comprises the antioxidant monothioglycerol present in an amount of from about 4 mg/mL to about 6 mg/mL of the composition.
The present invention relates to a method for treating a bacterial or protozoal infection in a mammal, comprising administering to a mammal in need of such treatment a therapeutically effective amount of a composition comprising: (a) the compound of formula I and the compound of formula II in a ratio of about 90%xc2x14% to about 10%xc2x14%, respectively; (b) water; and (c) one or more acids present at a total concentration of from about 0.2 mmol to about 1.0 mmol per mL of the composition.
The present invention also relates to a method for treating a bacterial or protozoal infection in a mammal, comprising administering to a mammal in need of such treatment an effective amount of a composition comprising: (a) a mixture comprising: (i) the compound of formula (I) and the compound of formula (II) in a ratio of about 90%xc2x14% to about 10%xc2x14%, respectively; (ii) water; and (iii) one or more acids present at a total concentration of from about 0.2 mmol to about 1.0 mmol per mL of the mixture; and (b) one or more water-miscible co-solvents present in a total amount of from about 250 to about 750 mg per mL of the composition.
In another preferred embodiment, the bacterial or protozoal infection is selected from the group consisting of bovine respiratory disease, swine respiratory disease, pneumonia, coccidiosis, anaplasmosis, and infectious keratinitis. In other preferred embodiments, the method comprises administering to a mammal in need of such treatment a therapeutically effective amount of any of the compositions or embodiments thereof described herein.
This invention also relates to a compound of the formula: 
or a pharmaceutically acceptable salt thereof;
wherein R1 is OH or 
and wherein R2 is H or CH3. In a preferred embodiment thereof, R1 is OH. In another preferred embodiment thereof, R2 is H. In another preferred embodiment thereof, R2 is CH3.
The present invention may be understood more fully by reference to the detailed description and illustrative examples which are intended to exemplify non-limiting embodiments of the invention.

The present invention relates to pharmaceutical compositions comprising isomer I and isomer II (collectively the xe2x80x9cazalide isomersxe2x80x9d) in a ratio of about 90%xc2x14% to about 10%xc2x14%. The chemical name of isomer I is (2R,3S,4R,5R,8R,10R,11R,12S,13S,14R)-13-((2,6-dideoxy-3-C-methyl-3-O-methyl-4-C-((propylamino)-methyl)-xcex1-L-ribo-hexopyranosyl)oxy-2-ethyl-3,4,10-trihydroxy-3,5,8,10,12,14-hexamethyl-11-((3,4,6-trideoxy-3-(dimethylamino)-xcex2-D-xylo-hexopyranosyl)oxy)-1-oxa-6-azacyclopentadecan-15-one. The chemical name of isomer II is (3R,6R,8R,9R,10S,11S,12R)-11-((2,6-dideoxy-3-C-methyl-3-O-methyl-4-C-((propylamino)methyl-xcex1-L-ribo-hexopyranosyl)oxy)-2-((1R,2R)-1,2-dihydroxy-1-methylbutyl)-8-hydroxy-3,6,8,10,12-pentamethyl-9-((3,4,6-trideoxy-3-(dimethylamino)-xcex2-D-xylo-hexopyranosyl)oxy)-1-oxa-4-azacyclotridecan-13-one. Isomer I can be formed from a translactonization reaction of isomer II. Likewise, isomer II can be formed from a translactonization reaction of isomer I. Methods for obtaining isomer I are disclosed in International publication no. WO 98/56802, incorporated herein by reference. Methods for obtaining isomer II are in disclosed Example 1, below. The azalide isomers are active antibiotic agents. Without being bound by any theory, the invention is based in part on Applicant""s surprising discovery that a composition comprising isomer I and isomer II in a ratio of about 90%xc2x14% to about 10%xc2x14% can be obtained rapidly using the methods disclosed herein independent of the starting ratio of the azalide isomers. While not absolutely certain, applicant believes that the about 90%xc2x14% to about 10%xc2x14% ratio of isomer I and isomer II constitutes an equilibrium mixture of the azalide isomers. Accordingly, the term xe2x80x9cequilibrium mixture of isomersxe2x80x9d as used herein refers to a mixture of isomer I and isomer II in a ratio of bout 90%xc2x14% to about 10%xc2x14%, respectively. An antibiotic composition comprising the equilibrium mixture of isomers can be consistently produced and provides a standard for testing or consumer use. Thus, a composition comprising the equilibrium mixture of isomers is highly desirable.
The present invention further relates to a method for preparing a composition comprising an equilibrium mixture of isomers. In one embodiment, the equilibrium mixture of isomers is obtained from a solution of substantially pure isomer I. By xe2x80x9csubstantially purexe2x80x9d, as used herein, unless otherwise indicated, is meant having a purity of at least 97%. In another embodiment, the equilibrium mixture of isomers is obtained from a solution comprising a mixture of isomer I and isomer II. In general, an equilibrium mixture of isomers is generated by heating a water solution of isomer I, preferably substantially pure isomer I, or a mixture of isomer I and isomer II, in the presence of one or more acids. In a preferred embodiment, a water solution of isomer I and one or more acids is heated to a temperature of between about 50xc2x0 C. to about 90xc2x0 C., preferably about 60xc2x0 C. to about 80xc2x0 C., for about 0.5 to about 24 hours, preferably about 1 to about 10 hours, at a pH of about 5.0 to about 8.0, preferably from about 6.0 to about 8.0. Most preferably, a solution of isomer I and isomer II is heated to a temperature of between about 65xc2x0 C. to about 75xc2x0 C. for about 1 to about 8 hours at a pH of about 6.5 to 7.5 in the presence of one or more acids. The concentration of isomer I or the mixture of isomer I and isomer II to be equilibrated can vary from about 50 mg/mL to about 500 mg/mL, preferably from about 100 mg/mL to about 300 mg/mL, and most preferably from about 225 mg/mL to about 275 mg/mL of solution.
Suitable acids useful for obtaining the equilibrium mixture of isomers include, but are not limited to, acetic acid, benzenesulfonic acid, citric acid, hydrobromic acid, hydrochloric acid, D- and L-lactic acid, methanesulfonic acid, phosphoric acid, succinic acid, sulfuric acid, D- and L-tartaric acid, p-toluenesulfonic acid, adipic acid, aspartic acid, camphorsulfonic acid, 1,2-ethanedisulfonic acid, laurylsulfuric acid, glucoheptonic acid, gluconic acid, 3-hydroxy-2-naphthoic acid, 1-hydroxy-2-naphthoic acid, 2-hydroxyethanesulfonic acid, malic acid, mucic acid, nitric acid, naphthalenesulfonic acid, palmitic acid, D-glucaric acid, stearic acid, maleic acid, malonic acid, fumaric acid, benzoic acid, cholic acid, ethanesulfonic acid, glucuronic acid, glutamic acid, hippuric acid, lactobionic acid, lysinic acid, mandelic acid, napadisylic acid, nicotinic acid, polygalacturonic acid, salicylic acid, sulfosalicylic acid, tryptophanic acid, and mixtures thereof. Preferably, the one or more acids are citric and hydrochloric acid. When present, citric acid is present at a concentration of from about 0.02 mmol to about 0.3 mmol per mL of solution. In one embodiment, an acid concentration of from about 0.2 mmol to about 1.0 mmol per mL of solution is used. Without being bound by any theory, applicant believes the salt formed from the addition of an acid to a solution of isomer I exerts a buffering effect, because the azalide isomers themselves act as a base. Those of skill in the art will recognize that the amount of acid required for a desired pH will vary according to which acid is used, and that, in order to maintain a pH within the desired range, additional acid and/or a base may be added to the solution of acid and isomer I, or mixture of isomer I and isomer II. Suitable bases include, but are not limited to, alkali metal hydroxides and carbonates, alkali metal bicarbonates, and alkaline earth hydroxides and carbonates. Sodium hydroxide and potassium hydroxide are preferred. The acids and bases described above are conveniently used in the form of their aqueous solutions.
Compositions comprising the equilibrium mixture of isomers (the xe2x80x9cequilibrated compositionsxe2x80x9d) are useful for treating a bacterial or protozoal infection in a mammal. The equilibrated compositions are also useful as intermediates for the formation of stabilized, equilibrated compositions.
The present invention further relates to stabilized, equilibrated compositions and to methods of stabilizing them comprising diluting the equilibrated compositions with one or more water-miscible organic solvents (xe2x80x9cco-solventxe2x80x9d). The co-solvent does not significantly affect the ratio of isomer I and isomer II in the equilibrated compositions, and in fact preserves their structural integrity. xe2x80x9cPreserving the structural integrityxe2x80x9d of isomer I or isomer II as used herein, includes, but is not limited to, retarding their rate of hydrolysis to, for example, descladinose azalide, and retarding their rate of byproduct formation of, for example, a formaldehyde and an acetaldehyde insertion product, defined below. Without being bound by any theory, Applicant believes that dilution with co-solvent improves the stability of the azalide isomers. Moreover, by virtue of the presence of co-solvent, any pain experienced upon injection of the stabilized, equilibrated compositions may be less than that experienced from injection of an equilibrated composition not so stabilized. Co-solvents useful for stabilizing the equilibrated compositions include, but are not limited to, alcohols such as ethanol and isopropanol; glycol ethers such as diethylene glycol monomethyl ether, diethylene glycol butyl ether, diethylene glycol monoethyl ether and diethylene glycol dibutyl ether; polyethylene glycols such as polyethylene glycol-300 and polyethylene glycol-400; glycols such as propylene glycol (xe2x80x9cPGxe2x80x9d) and glycerine; pyrrolidones such as 2-pyrrolidone and N-methyl 2-pyrrolidone; glycerol formal; dimethyl sulfoxide; dibutyl sebecate; polyoxyethylene sorbitan esters such as polysorbate 80; and mixtures thereof. Preferably, co-solvents useful for stabilizing the equilibrated compositions in injectable solutions include, but are not limited to, ethanol, polyethylene glycols such as polyethylene glycol-300 and polyethylene glycol-400, glycols such as propylene glycol and glycerine, pyrrolidones such as 2-pyrrolidone and N-methyl 2-pyrrolidone, glycerol formal, dimethyl sulfoxide, polyoxyethylene sorbitan esters such as polysorbate 80, and mixtures thereof, more preferably, glycerol formal, N-methyl 2-pyrrolidone and propylene glycol, and most preferably, propylene glycol. In one embodiment, co-solvent in an amount of about 250 to about 750 mg per mL of the pharmaceutical compositions is used to stabilize them. In a preferred embodiment, about 400 to about 600 mg of co-solvent per mL of the pharmaceutical compositions is used. In a most preferred embodiment, about 450 to about 550 mg of co-solvent per mL of the pharmaceutical compositions is used.
In one embodiment, one or more co-solvents are added to isomer I or to a mixture of isomer I and isomer II prior to equilibration. In this case, the resulting mixture is heated to a temperature of between about 50xc2x0 C. to about 90xc2x0 C., preferably about 60xc2x0 C. to about 80xc2x0 C. for about 0.5 to about 24 hours, preferably for about 1 to about 10 hours, at a pH of about 5.0 to about 8.0, preferably at a pH of about 6.0 to about 8.0. In a preferred embodiment, equilibration of the azalide isomers is carried out in the absence of co-solvent, which is added to the equilibrated compositions after they have cooled to about room temperature.
After addition of the co-solvent, the pH of the resulting solution can be re-adjusted to further improve stability of the composition. The pH is adjusted by methods known to those skilled in the art, such as for example by adding an amount of acid or base described above, e.g., as a 10% (w/w) stock solution, and measuring the pH of the resulting solution using, e.g., a pH meter. In one embodiment, the pH of the resulting solution, if necessary, is adjusted to about 4.5 to about 7.5, preferably about 5.0 to about 6.0, most preferably, about 5.2 to about 5.6.
The present invention further relates to pharmaceutical compositions comprising an equilibrium mixture of isomers, water, one or more acids, and one or more water-miscible co-solvents. The amount of azalide isomers in the pharmaceutical compositions ranges from about 50 mg of azalide isomers per mL of pharmaceutical composition to about 200 mg of azalide isomers per mL of pharmaceutical composition. Preferably, the pharmaceutical compositions comprise from about 75 mg to about 150 mg, more preferably, from about 90 to about 110 mg, of azalide isomers per mL of pharmaceutical composition.
The pharmaceutical compositions can still further comprise one or more antioxidants. Antioxidants retard the rate of or prevent oxidative breakdown of the pharmaceutical compositions. Suitable antioxidants include, but are not limited to, sodium bisulfite, sodium sulfite, sodium metabisulfite, sodium thiosulfate, sodium formaldehyde sulfoxylate, L-ascorbic acid, erythorbic acid, acetylcysteine, cysteine, monothioglycerol (xe2x80x9cMTGxe2x80x9d), thioglycollic acid, thiolactic acid, thiourea, dithiothreitol, dithioerythreitol, glutathione, ascorbyl palmitate, butylated hydroxyanisole, butylated hydroxytoluene, nordihydroguaiaretic acid, propyl gallate, xcex1-tocopherol, and mixtures thereof. Those of skill in the art will recognize that the amount of antioxidant will vary according to which antioxidant is used. In a preferred embodiment, the antioxidant, when present, is present in an amount of from about 0.01 mg to about 10 mg per mL of pharmaceutical composition. In a more preferred embodiment, the antioxidant is monothioglycerol and present in an amount of from about 1 mg to about 8 mg per mL of pharmaceutical composition. In a most preferred embodiment, the antioxidant is monothioglycerol and present in an amount of from about 4 mg to about 6 mg per mL of pharmaceutical composition.
The pharmaceutical compositions optionally comprise one or more preservatives. Preservatives are useful for retarding the rate of or preventing proliferation of microorganisms, particularly when the pharmaceutical compositions are exposed to air. Useful preservatives are: effective against a broad spectrum of microorganisms; physically, chemically and microbiologically stable over the lifetime of the pharmaceutical compositions; non-toxic; adequately soluble; compatible with other components of the composition; and acceptable with respect to taste and odor. Suitable preservatives include, but are not limited to, benzalkonium chloride, benzethonium chloride, benzoic acid, benzyl alcohol, methylparaben, ethylparaben, propylparaben, butylparaben, sodium benzoate, phenol, and mixtures thereof. In a preferred embodiment, the one or more preservatives are selected from the group consisting of benzyl alcohol, methylparaben, propylparaben, a methylparaben/propylparaben combination, and phenol. When present, the one or more preservatives are present in an amount of from about 0.01 to about 10 mg per mL of the pharmaceutical compositions. Preferably, the one or more preservatives is phenol and present in an amount of from about 2.0 to about 5.0 mg per mL, more preferably, from about 2.0 to about 3.0 mg per mL, of the pharmaceutical compositions. One of skill in the art will recognize that the amount of preservative to be used in the present compositions will depend on which preservative is chosen, and that some preservatives may be used at lower concentrations, even lower than about 0.01 mg per mL of the pharmaceutical compositions.
In a preferred embodiment, the pharmaceutical compositions of the invention have a pH of from about 5.0 to about 7.0 and comprise: (1) an equilibrium mixture of isomers present in an amount of from about 50 mg to about 200 mg per mL of the pharmaceutical composition; (2) citric acid present in a concentration of from about 0.02 mmol to about 0.3 mmol per mL of the pharmaceutical composition and, optionally, an amount of hydrochloric acid effective to achieve the pH range; (3) propylene glycol, present in an amount of from about 250 to about 750 mg per mL of the pharmaceutical composition; (4) monothioglycerol, present in an amount of from about 1 mg to about 15 mg per mL of the pharmaceutical composition; and (5) water, present in an amount of from about 100 to about 750 mg per mL of the pharmaceutical composition.
In a more preferred embodiment, the pharmaceutical compositions of the invention have a pH of from about 5.0 to about 6.0 and comprise: (1) an equilibrium mixture of isomers present in an amount of from about 75 mg to about 150 mg per mL of the pharmaceutical composition; (2) citric acid present in an amount of from about 0.05 mmol to about 0.15 mmol per mL of the pharmaceutical composition and, optionally, an amount of hydrochloric acid effective to achieve the pH range; (3) propylene glycol, present in an amount of from about 400 to about 600 mg per mL of the pharmaceutical composition; (4) monothioglycerol, present in an amount of from about 1 mg to about 8 mg per mL of the pharmaceutical composition; and (5) water, present in an amount of from about 250 to about 550 mg per mL of the pharmaceutical composition.
In a most preferred embodiment, the pharmaceutical compositions of the invention have a pH of from about 5.2 to about 5.6 and comprise: (1) an equilibrium mixture of isomers present in an amount of from about 90 mg to about 110 mg per mL of the pharmaceutical composition; (2) citric acid present in an amount of from about 0.075 mmol to about 0.125 mmol per mL of the pharmaceutical composition, and an amount of hydrochloric acid effective to achieve the pH range; (3) propylene glycol, present in an amount of from about 450 to about 550 mg per mL of the pharmaceutical composition; (4) monothioglycerol, present in an amount of from about 4 mg to about 6 mg per mL of the pharmaceutical composition; and (5) water, present in an amount of from about 300 to about 500 mg per mL of the pharmaceutical composition.
The pharmaceutical compositions can be prepared as follows. Reagents are added in a stainless steel- or glass-lined jacketed vessel with optional nitrogen overlay. Water for Injection is added to the reaction vessel, and agitation is begun. Each additional component is added while the mixture is continuously agitated. Acid in a concentration of about 0.02 mmol to about 0.5 mmol per mL of water is added and allowed to dissolve. An aqueous solution of an acid, e.g., a 10% (w/w) aqueous solution of hydrochloric acid, is optionally added to adjust the pH to a desired range and the solution is mixed. At this point, isomer I, or a mixture of isomer I and isomer II, is added to the water and acid mixture slowly and in small quantities to avoid clumping. Isomer I, or a mixture of isomer I and isomer II, is allowed to dissolve, and the pH of the resulting solution is measured. In one embodiment, the concentration of isomer I or the mixture of isomer I and isomer II is from about 50 mg to about 500 mg per mL, preferably from about 100 to about 300 mg per mL, and most preferably from about 225 to about 275 mg per mL, of the resulting solution. The solution is then heated to a temperature of about 70xc2x0 C.xc2x110xc2x0 C. and is maintained at this temperature until an equilibrium mixture of isomers is obtained. Methods for determining that an equilibrium mixture of isomers has been obtained include gel chromatography, thin-layer chromatography, and high-performance liquid chromatography. Generally, using the conditions described herein, an equilibrium mixture of isomers is obtained in about 1 to about 8 hours. Once the equilibrium mixture of isomers is obtained, the resulting solution is cooled to about 25xc2x0 C.xc2x110xc2x0 C. This solution can be used as a pharmaceutical composition. Preferably, co-solvent is added in an amount of from about 250 to about 750 mg per mL of the pharmaceutical composition. Antioxidant is optionally added in an amount of from about 0.01 mg to about 10 mg per mL of the pharmaceutical composition. If present, preservative is added in an amount of from about 0.01 to about 10 mg per mL of the pharmaceutical composition, and the pH is adjusted to about 5.0 to about 8.0, preferably to about 5.0 to about 6.0, by adding acid and/or base, for example, as a 10% (w/w) aqueous solution or in solid form. The resulting mixture is diluted to a desired volume. In one embodiment, the final concentration of the equilibrium mixture of isomers is about 50 mg to about 200 mg, preferably about 75 mg to about 150 mg, and most preferably about 90 mg to about 110 mg per mL of the resulting pharmaceutical composition.
The resulting compositions are preferably sterilized, for example, by passing the compositions through a pre-filter, e.g., a 5-10 micron filter and then through a 0.2 micron final sterilizing filter that has been previously sterilized. The sterilizing filter is sterilized by moist-heat autoclaving for 60 minutes at 121xc2x0 C., and is tested for integrity using a pressure-hold method prior to sterilization and after product filtration. The sterile solution is added to suitable containers, e.g., glass vials, that are sterilized and depyrogenated at 250xc2x0 C. for 240 minutes in a dry-heat tunnel. The container head-space is flushed with an inert gas, e.g., argon or preferably, nitrogen. The containers are capped with stoppers that are depyrogenated by washing and sterilized by moist-heat autoclaving for 60 minutes at 121xc2x0 C. The containers are then over-sealed. Those skilled in the art will recognize that minor modifications to the above can be used to prepare sterile compositions.
The present invention further relates to methods for treating a mammal, comprising administering to a mammal in need of such treatment a pharmaceutically effective amount of a pharmaceutical composition of the invention. The pharmaceutical compositions of the invention can be used to treat infections by gram-positive bacteria, gram-negative bacteria, protozoa, and mycoplasma, including, but not limited to, Actinobacillus pleuropneumonia, Pasteurella muitocida, Pasteurella haemolytica, H. parasuis, B. bronchiseptica, S. choleraesuis, S. pilo, Moraxella bovis, H. somnus, M. bovis, Eimeria zuernii, Eimeria bovis, A. marginale, M. hyopneumoniae, Lawsonia intracellularis, and staphylococcus, salmonella, chlamydia, coccidia, cryptosporidia, E. coli, haemophilus, neospora, and streptococcus species.
The term xe2x80x9ctreatmentxe2x80x9d, as used herein, unless otherwise indicated, includes the treatment or prevention of a bacterial infection or protozoal infection as provided in the method of the present invention.
As used herein, unless otherwise indicated, the terms xe2x80x9cbacterial infection(s)xe2x80x9d and xe2x80x9cprotozoal infection(s)xe2x80x9d include bacterial infections and protozoal infections that occur in mammals, fish and birds as well as disorders related to bacterial infections and protozoal infections that may be treated or prevented by administering antibiotics such as the compounds of the present invention. Such bacterial infections and protozoal infections, and disorders related to such infections, include the following: pneumonia, otitis media, sinusitus, bronchitis, tonsillitis, and mastoiditis related to infection by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, or Peptostreptococcus spp.; pharynigitis, rheumatic fever, and glomerulonephritis related to infection by Streptococcus pyogenes, Groups C and G streptococci, Clostridium diptheriae, or Actinobacillus haemolyticum; respiratory tract infections related to infection by Mycoplasma pneumoniae, Legionella pneumophila, Streptococcus pneumoniae, Haemophilus influenzae, or Chlamydia pneumoniae; uncomplicated skin and soft tissue infections, abscesses and osteomyelitis, and puerperal fever related to infection by Staphylococcus aureus, coagulase positive staphylococci (i.e., S. epidermidis, S. hemolyticus, etc.), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcal groups C-F (minute-colony streptococci), viridans streptococci, Corynebacterium minutissimum, Clostridium spp., or Bartonella henselae; uncomplicated acute urinary tract infections related to infection by Staphylococcus saprophyticus or Enterococcus spp.; urethritis and cervicitis; and sexually transmitted diseases related to infection by Chlamydia trachomatis, Haemophilus ducreyi, Treponema pallidum, Ureaplasma urealyticum, or Neiserria gonorrheae; toxin diseases related to infection by S. aureus (food poisoning and Toxic shock syndrome), or Groups A, B, and C streptococci; ulcers related to infection by Helicobacter pylori; systemic febrile syndromes related to infection by Borrelia recurrentis; Lyme disease related to infection by Borrelia burgdorferi; conjunctivitis, keratitis, and dacrocystitis related to infection by Chlamydia trachomatis, Neisseria gonorrhoeae, S. aureus, S. pneumoniae, S. pyogenes, H. influenzae, or Listeria spp.; disseminated Mycobacterium avium complex (MAC) disease related to infection by Mycobacterium avium, or Mycobacterium intracellulare; gastroenteritis related to infection by Campylobacter jejuni; intestinal protozoa related to infection by Cryptosporidium spp.; odontogenic infection related to infection by viridans streptococci; persistent cough related to infection by Bordetella pertussis; gas gangrene related to infection by Clostridium perfringens or Bacteroides spp.; and atherosclerosis related to infection by Helicobacter pylori or Chlamydia pneumoniae. Bacterial infections and protozoal infections and disorders related to such infections that may be treated or prevented in animals include the following: bovine respiratory disease related to infection by P. haem., P. multocida, Mycoplasma bovis, or Bordetella spp.; cow enteric disease related to infection by E. coil or protozoa (i.e., coccidia, cryptosporidia, etc.); dairy cow mastitis related to infection by Staph. aureus, Strep. uberis, Strep. agalactiae, Strep. dysgalactiae, Klebsiella spp., Corynebacterium, or Enterococcus spp.; swine respiratory disease related to infection by A. pleuro., P. multocida, or Mycoplasma spp.; swine enteric disease related to infection by E col, Lawsonia intracellularis, Salmonella, or Serpulina hyodyisinteriae; cow footrot related to infection by Fusobacterium spp.; cow metritis related to infection by E. coli; cow hairy warts related to infection by Fusobacterium necrophorum or Bacteroides nodosus; cow pink-eye related to infection by Moraxella bovis; cow premature abortion related to infection by protozoa (i.e. neosporium); urinary tract infection in dogs and cats related to infection by E. coli; skin and soft tissue infections in dogs and cats related to infection by Staph. epidermidis, Staph. intermedius, coagulase neg. Staph. or P. multocida; and dental or mouth infections in dogs and cats related to infection by Alcaligenes spp., Bacteroides spp., Clostridium spp., Enterobacter spp., Eubacterium, Peptostreptococcus, Porphyromonas, or Prevotella. Other bacterial infections and protozoal infections and disorders related to such infections that may be treated or prevented in accord with the method of the present invention are referred to in J. P. Sanford et al., xe2x80x9cThe Sanford Guide To Antimicrobial Therapy,xe2x80x9d 26th Edition, (Antimicrobial Therapy, Inc., 1996).
The antibacterial and antiprotozoal activity of the compounds of the present invention against bacterial and protozoa pathogens is demonstrated by the compounds"" ability to inhibit growth of defined strains of human or animal pathogens.
Assay I, described below, employs conventional methodology and interpretation criteria and is designed to provide direction for chemical modifications that may lead to compounds that circumvent defined mechanisms of macrolide resistance. In Assay I, a panel of bacterial strains is assembled to include a variety of target pathogenic species, including representatives of macrolide resistance mechanisms that have been characterized. Use of this panel enables the chemical structure/activity relationship to be determined with respect to potency, spectrum of activity, and structural elements or modifications that may be necessary to obviate resistance mechanisms. Bacterial pathogens that comprise the screening panel are shown in the table below. In many cases, both the macrolide-susceptible parent strain and the macrolide-resistant strain derived from it are available to provide a more accurate assessment of the compounds"" ability to circumvent the resistance mechanism. Strains that contain the gene with the designation of ermA/ermB/ermC are resistant to macrolides, lincosamides, and streptogramin B antibiotics due to modifications (methylation) of 23S rRNA molecules by an Erm methylase, thereby generally prevent the binding of all three structural classes. Two types of macrolide efflux have been described; msrA encodes a component of an efflux system in staphylococci that prevents the entry of macrolides and streptogramins while mefA/E encodes a transmembrane protein that appears to efflux only macrolides. Inactivation of macrolide antibiotics can occur and can be mediated by either a phosphorylation of the 2N-hydroxyl (mph) or by cleavage of the macrocyclic lactone (esterase). The strains may be characterized using conventional polymerase chain reaction (PCR) technology and/or by sequencing the resistance determinant. The use of PCR technology in this application is described in J. Sutcliffe et al., xe2x80x9cDetection Of Erythromycin-Resistant Determinants By PCRxe2x80x9d, Antimicrobial Agents and Chemotherapy, 40(11), 2562-2566 (1996). The assay is performed in microtiter trays and interpreted according to Performance Standards for Antimicrobial Disk Susceptibility Testsxe2x80x94Sixth Edition; Approved Standard, published by The National Committee for Clinical Laboratory Standards (NCCLS) guidelines; the minimum inhibitory concentration (MIC) is used to compare strains. The equilibrium mixture of azalide isomers is initially dissolved in dimethylsulfoxide (DMSO) as a 40 mg/ml stock solution.
Assay II is utilized to test for activity against Pasteurella multocida and Assay III is utilized to test for activity against Pasteurella haemolytica.
This assay is based on the liquid dilution method in microliter format. A single colony of P. multocida (strain 59A067) is inoculated into 5 ml of brain heart infusion (BHI) broth. The equilibrium mixture of azalide isomers is prepared by solubilizing 1 mg of the mixture in 125 xcexcl of dimethylsulfoxide (DMSO). Dilutions of the equilibrium mixture of azalide isomers are prepared using uninoculated BHI broth. The concentrations of the equilibrium mixture of azalide isomers used range from 200 xcexcg/mL to 0.098 xcexcg/mL by two-fold serial dilutions. The P. multocida inoculated BHI is diluted with uninoculated BHI broth to make a 104 cell suspension per 200 xcexcL. The BHI cell suspensions are mixed with respective serial dilutions of the equilibrium mixture of azalide isomers, and incubated at 37xc2x0 C. for 18 hours. The minimum inhibitory concentration (MIC) is equal to the concentration of the mixture exhibiting 100% inhibition of growth of P. multocida as determined by comparison with an uninoculated control.
This assay is based on the agar dilution method using a Steers Replicator. Two to five colonies isolated from an agar plate are inoculated into BHI broth and incubated overnight at 37xc2x0 C. with shaking (200 rpm). The next morning, 300 xcexcL of the fully grown P. haemolytica preculture is inoculated into 3 ml of fresh BHI broth and is incubated at 37xc2x0 C. with shaking (200 rpm). The appropriate amounts of the equilibrium mixture of azalide isomers are dissolved in ethanol and a series of two-fold serial dilutions are prepared. Two mL of the respective serial dilution is mixed with 18 mL of molten BHI agar and solidified. When the inoculated P. haemolytica culture reaches 0.5 McFarland standard density, about 5 xcexcL of the P. haemolytica culture is inoculated onto BHI agar plates containing the various concentrations of the equilibrium mixture of azalide isomers using a Steers Replicator and incubated for 18 hours at 37xc2x0 C. Initial concentrations of the mixture range from 100-200 xcexcg/mL. The MIC is equal to the concentration of the mixture exhibiting 100% inhibition of growth of P. haemolytica as determined by comparison with an uninoculated control.
Most preferably, the microdilution assay is performed using cation-adjusted Mueller-Hinton broth according to NCCLS guideline M31-A, Vol. 19, No. 11, xe2x80x9cPerformance standards for antimicrobial disk and dilution susceptibility tests for bacteria isolated from animals,xe2x80x9d June 1999 (ISBN 1-56238-377-9), which is herein incorporated by reference. This assay may be used to determine the MIC of a compound against both P. haemolytica and P. multocida. For example, the equilibrium mixture of isomers was tested according to this standard, against P. haemolytica (ATCC 14003), and found to have a MIC of 1 xcexcg/mL. When the equilibrium mixture of isomers was tested according to this standard, against P. multocida (ATCC 43137), the MIC was found to be 1 xcexcg/mL.
The in vivo activity of the pharmaceutical compositions of the present invention can be determined by conventional animal protection studies well known to those skilled in the art, usually carried out in mice.
Mice are allotted to cages (10 per cage) upon their arrival, and allowed to acclimate for a minimum of 48 hours before being used. Animals are inoculated with 0.5 ml of a 3xc3x97103 CFU/ml bacterial suspension (P. multocida strain 59A006) intraperitoneally. Each experiment has at least 3 non-medicated control groups including one infected with 0.1xc3x97challenge dose and two infected with 1xc3x97challenge dose; a 10xc3x97challenge data group may also be used. Generally, all mice in a given study can be challenged within 30-90 minutes, especially if a repeating syringe (such as a Cornwall7 syringe) is used to administer the challenge. Thirty minutes after challenging has begun, the first pharmaceutical composition treatment is given. It may be necessary for a second person to begin pharmaceutical composition dosing if all of the animals have not been challenged at the end of 30 minutes. The routes of administration are subcutaneous or oral doses. Subcutaneous doses are administered into the loose skin in the back of the neck whereas oral doses are given by means of a feeding needle. In both cases, a volume of 0.2 ml is used per mouse. Compositions are administered 30 minutes, 4 hours, and 24 hours after challenge. A control composition of known efficacy administered by the same route is included in each test. Animals are observed daily, and the number of survivors in each group is recorded. The P. multocida model monitoring continues for 96 hours (four days) post challenge.
The PD50 is a calculated dose at which the pharmaceutical composition tested protects 50% of a group of mice from mortality due to the bacterial infection which would be lethal in the absence of treatment.
The pharmaceutical compositions of the present invention show antibacterial activity in one of the above-described assays, particularly in Assay IV.
The pharmaceutical compositions of the invention can be used to treat humans, cattle, horses, sheep, swine, goats, rabbits, cats, dogs, and other mammals in need of such treatment. In particular, the pharmaceutical compositions of the invention can be used to treat, inter alia, bovine respiratory disease, swine respiratory disease, pneumonia, pasteurellosis, coccidiosis, anaplasmosis, and infectious keratinitis. The pharmaceutical compositions may be administered through oral, intramuscular, intravenous, subcutaneous, intra-ocular, parenteral, topical, intravaginal, or rectal routes. For administration to cattle, swine or other domestic animals, the pharmaceutical compositions may be administered in feed or orally as a drench composition. Preferably, the pharmaceutical compositions are injected intramuscularly, intravenously or subcutaneously. In a preferred embodiment, the pharmaceutical compositions are administered in dosages ranging from about 0.5 mg of the equilibrium mixture of isomers per kg of body weight per day (mg/kg/day) to about 20 mg/kg/day. In a more preferred embodiment, the pharmaceutical compositions are administered in dosages ranging from about 1 mg/kg/day to about 10 mg/kg/day. In a most preferred embodiment, the pharmaceutical compositions are administered in dosages ranging from about 1.25 mg/kg/day to about 5.0 mg/kg/day. The pharmaceutical compositions can be administered up to several times per day, for about 1 to about 15 days, preferably about 1 to about 5 days, and repeated where appropriate. Those of skill in the art will readily recognize that variations in dosages can occur depending upon the species, weight and condition of the subject being treated, its individual response to the pharmaceutical compositions, and the particular route of administration chosen. In some instances, dosage levels below the lower limit of the aforesaid ranges may be therapeutically effective, while in other cases still larger doses may be employed without causing any harmful side effects, provided that such larger doses are first divided into several small doses for administration throughout the day.